BRB +AM ARSE FE IUARO — BAR) AARRES Ministy of Justice Government of Japan ee Ae DF Th HR SB APPLICATION FOR PERMISSION TO ENGAGE IN ACTIVITY OTHER THAN THAT PERMITTED UNDER THE STATUS OF RESIDENCE PREVIOUSLY GRANTED AREER Bt TotheDiteclor Genera Regi gration Burea HALE ORES EIA 1 OA BZAO WEE SS, ROLE IMME ME BLED, Pursuant to the provisions of Paragraph 2 of Aci 19 ofthe Immigration Control and Refugee Recagaiton Act hereby ‘ppl for permission to engage in aves other than those permitted under the satus of residence previously grated 3K EMBAF ATCO SRA SERIE AETTOCL ACR SOIE, MBO RFAIC LOTS, DER REESE (3A OMMMERESMABSERS, ICRENET, Persons, who ae able toi or this aplication folowing acquisition of landing permission, ar ited to those wha ‘have baen grated the status f residence of Student’ ased on te landing pemission (excluding thase who have boen granted a period of say of tree (3} months), 1 Hh Nationally Region 2 EAB Ga A A Date of Bth Yea Month Day 3 & & Namen Engst) 40 Bo: ok sex Wale 1 Female FRAO / RRS ERE A A ‘Slonatue ofthe applicant / Date of ing in his form Year Month DaBRA + AO MB Hst (+ LAD — BR) ory Toles 0, nay fats me y Hw & a of # APPLICATION FOR PERMISSION TO ENGAGE IN ACTIVITY OTHER THAN THAT PERMITTED UNDER THE STATUS OF RESIDENCE PREVIOUSLY GRANTED Top lok 7° ABB Be ‘Tothe Director General Regional Immigration Bureau HAGE URERIB ER LIAB HOMIES, OLB EMOR TABLET, Pursuant tthe provision of Paragranh 2 of Arte 19 of he Immigrafon Control and Refugee Recogrion Act | hereby ply for permission fo engage in activities cher than those permiled under the status of residence previously rented, 3K LRA TTICS Se RG SMETANA CL CRON, LBRO AIC LYRE) CEMRGERESNBS (3A DERM MERESBA LR, IRENET, Persons, who are ble to fe for his application folowing accuston of landing perssion, are ited fo those who ‘nave bsen granted he status of residence of Student” based onthe landing permission (excluding those who have ‘been granted a period of slay of three (3} months) 1 BO He ae ‘Nationality / Region 2 ££ AB ia A a S- Date of Bit ea Wonth oy y ane a6 Co. 30 ok 4 — ‘Name {in English) ee Bos k 7 ; sex Wale} Fame HAO E4 / 8 ERE AA ‘Signature ofthe applicant / Date of filing inthis form